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NPI Code Detail

MEDICARE: DR. AMY MCDANIEL MOLINA PH.D.

MEDICARE: DR. AMY MCDANIEL MOLINA PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling PsychologistPSY.0005366CO
2103TS0200XSchool PsychologistPSY.0005366CO
3103TC0700XClinical PsychologistPSY.0005366CO

General Provider Information

NPI Number : 1659976967
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMY MCDANIEL MOLINA PH.D.
Provider Business Mailing Address
First Line : 2409 COPPER CREST LN
Second Line :
City : FORT COLLINS
State : CO
Zip : 80528-2400
Country : US
Telephone Number : 970-213-2620
Fax Number :
Provider Business Practice Location Address
First Line : 323 W DRAKE RD STE 216
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-8120
Country : US
Telephone Number : 720-900-1102
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2020
Last Update Date : 04/22/2021

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